As is known in the art, healthcare institutions are faced with the challenge to demonstrate the appropriateness and accuracy of high cost and high volume medical procedures in general and medical imaging procedures in particular. Utilization management hinges upon the ability to measure the utility of examinations/procedures performed and thus determine the appropriateness of dollars spent.
As is also known, many medical reports, including radiology reports, tend to be unstructured reports. An unstructured report corresponds to a report in which clinical findings and recommendations tend to be embedded and intermingled or interspersed within subjective prose which describes both anatomical and pathological variations in an inconsistent fashion. The current technique for objective classification of unstructured medical findings within reports, including radiology reports, is manual analysis. In particular, to determine whether a medical examination/procedure was appropriate, it is necessary to conduct extensive patient medical chart reviews to determine the appropriateness of the medical examinations/procedures performed. This patient medical chart review process is a manual process and thus is relatively time consuming. Thus, typically relatively small data sets, collected through manual evaluation of report and outcome data, are used to determine the appropriateness of a particular type of medical examination/procedure.
Furthermore, since the process involves individuals reviewing unstructured medical reports, the results are subjective. Moreover, since relatively small data sets are used, it is necessary to extrapolate the small data set to entire ordering practices of individuals and systems as a whole. Reliance on such extrapolation can result in inaccurate conclusions being drawn for a specific medical procedure, medical examination or medical practitioner.
There is currently no automated process to evaluate the findings, recommendations or utilization of relatively high cost medical examinations/procedures via unstructured reports. Since unstructured reports are typically the single result of many high cost diagnostic imaging procedures it is relatively difficult to evaluate utilization of such examinations/procedures. Insurance companies have an interest in evaluating the utilization of high cost medical procedures. Current methods available to insurance and other companies are to simply reduce high cost examinations in a global sense or perform the above-described chart review process to identify and track ordering physicians.
One readily available large scale measure of utilization, the volume of examinations ordered, is found to have questionable correlation to examination volume itself. For example, one medical institution may see an annual increase in certain procedures of 15%. By looking solely at this volume rise, it is very difficult to assume that the increase is due to over-utilization versus a simple increase in the appropriate use of imaging examinations, or what portion correlates to over-utilization at all. However, in the absence of other measures that are independent of volume, such as exam yield and recommendation rate, insurance companies are often left with this single indicator.
It would, therefore, be desirable to provide a system which helps determine the appropriate utilization of high cost medical examinations/procedures. It would also be desirable to provide a system and process which utilizes metrics to evaluate clinical findings and recommendations in unstructured medical reports in general.